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Brian Lehrer: Brian Lehrer on WNYC. Last week it was Pfizer and this morning you may have woken up to some news about the vaccine that Moderna has been working on early data shows that it's almost 95% effective, but there are challenges ahead who will get it first and how long will it be available for the general public? There's also a strange new politics between President Trump and Governor Cuomo over whether it will be available in New York. For details now on the vaccine and the distribution of it. I'm joined by Carl Zimmer, New York Times science columnist and author of Planet of Viruses. Hi, Carl. Welcome back to WNYC.

Carl Zimmer: Good to be back.

Brian: What's new from the Moderna?

Carl: Moderna has given us some really encouraging results. They have taken an early look at their clinical trial, there were 95 people so far who got sick with COVID, and when they took a look, they found that 90 of those 95 had a placebo only five had the vaccine and if you do that math, that leads you to an estimate that the vaccine is almost 95% effective, which is really great.

Brian: Last week, a lot of people saw that Pfizer's COVID vaccine was more than 90% effective, and that, of course, was encouraging news. Now Moderna is saying 94% for theirs. What are the differences between Pfizer's vaccine and Moderna's?

Carl: Actually, they're more similar than different, I will say because they are both based on a very particular way of building a vaccine. Essentially, they both deliver the same genetic instruction into our cells and then our cells make viral proteins, which then stimulate the immune system. This approach has never been used before in a licensed vaccine. It's been studied for years and so people were waiting to see how this would actually work out in clinical trials.

In both cases, they've got very strong results, very close to each other. The big difference I would say would be actually how you get it because Pfizer's needs to be kept really cold, like -112 degrees Fahrenheit, Moderna's is is a little easier.

Brian: Can we just stop and think about this for a second, by the way, I know these numbers have gone by the last few weeks, but people probably don't even register how cold that is and what a storage challenge it requires. I heard -94 degrees Fahrenheit last week, you're saying -112, the freezers on our refrigerators are set at zero. That's pretty cold, right? Zero degrees. Your freezer is zero degrees to keep something at -100, oh my goodness.

Carl: You're not going to be putting this in your fridge. Pfizer is working on special boxes that they will deliver the vaccines in. Basically, they will ship these vaccines in ultra-cold containers and people will be able to keep those vaccines in those containers until they're needed to be used. Now--

Brian: Does my doctor's office, does my local urgent care have units that can store things at -100 degrees.

Carl: No, they're going to be getting it from Pfizer, if all goes well. It's less of an issue with Moderna because Moderna's vaccine only needs to be kept at a minus four Fahrenheit and that's still your freezer at home is not going to cut it, but still that's a lot easier to manage. It also turns out they've found that the vaccines can-- While it's shipped at negative four Fahrenheit, it can actually be stored like at your doctor's office refrigerated for 30 days. That could be a big difference.

Brian: Will individuals be able to choose like you can buy a Toyota or a Chevy? I think I'll take the Pfizer vaccine, assuming that it's shippable at those temperatures and storable and all of that, we'll read consumer reports and we'll see which is supposed to be better than Moderna vaccine or the Pfizer vaccine or maybe some others that are going to come along. Is it going to be that market choice?

Carl: It could be maybe in the summer or fall of 2021, but in the initial stages it's going to be all that people can do to get one of these vaccines to as many people as possible. The distribution will be, will actually be quite limited at first so if these, if one or two of these vaccines gets authorized and that's still a big if, then they're only going to have on the order of maybe enough for say about 20 million people at first, maybe 20, 30 million people. Who are those people going to be? Probably healthcare workers will be at the front of the line and then they're going to have to be decisions about who else gets it next and so on. If you get the option to get a vaccine, you probably aren't going to get like a big choice at first

Brian: Listeners who has questions about vaccine development and distribution with this news from Moderna today that it's got a vaccine as ready to go as the one we were hearing about last week from Pfizer with about 90% effectiveness in these clinical trials, 646-435-7280, for Carl Zimmer, who writes about science for New York Times 646-435-7280. He's also author of the book, Planet of Viruses, you can also tweet a question @BrianLehrer if you have one.

You know what occurs to me just in terms of politics and human psychology, you know how there's been so much said in so many polls taken about people's reluctance to get a vaccine. They don't know if they're going to trust it. They don't know if they're going to trust it because they don't trust vaccines in general, because it's too new and you don't know if it's safe over the long-term because it comes from the Trump approval process and he's politicized it so much. Any of those things.

I have a feeling this may flip any day now to instead of worrying about whether you should take it, the worry will become over who can get access? Because as soon as there's a shortage of something, everybody scrambles to get access and whether it's a toy at Christmas time that sells out on December 3rd or whatever it is, once there's a shortage and access is a question of status or anything else or just ability to access something easily, then the psychology of it flips. I don't know how much that's going to happen because those other things that might make people reluctant are still in play, but Carl, I think I see this starting to turn,

Carl: I sure hope so because what we need as a society is for people to feel confidence in these vaccines so that lots of people get it because it's not just about protecting yourself. Mass vaccination will just drive down the virus across the country. People talk a lot. You may hear phrase these days about herd immunity for vaccine researchers.

What that means is that if enough people get vaccinated, it gets really hard for the virus to find a new susceptible host and it just becomes rarer and rarer, but even for a vaccine that's a hundred percent affective you'd need somewhere between 60% and 78% of everyone to get it, to get the herd immunity to kick in. If it's 80% effective, then you're going to need more, 75% to 90%. We need people who are enthusiastic about vaccines and people who have hesitations to get it too and that's going to require a lot of good, clear, consistent communication, which we have had in short supply recently.

Brian: By the way, a lot of comments on the Pfizer vaccine storage requirements and a number of people are pointing out that dry ice is that cold so that would provide the temperature needed for the vaccine to remain stored and dry ice as a common commodity, but then other people are saying, doctors do not have that real estate to keep thousands of jars in a low temperature fridge or freezer in dry ice. That conversation goes on. Governor Cuomo spoke at Manhattan's Riverside Church yesterday and he said the communities who've been disproportionately affected by COVID should be at the top of the list when it comes to getting the vaccine. Here's that clip

Governor Cuomo: Black and brown communities that were first on the list of who died cannot be last on the list of who receives the vaccine, period.

Brian: Carl, that's an important thing to say, but how does it become a part of the official vaccine rollout?

Carl: Well, we're going to see that. There have to be priorities in terms of who gets the vaccine, who gets it first, and in addition to healthcare workers who we all depend on and we need to keep their staffing numbers high then becomes, "Well, who's at most at risk?" Certainly, Black and brown communities have been hit so hard. Hospitalization rates like in New York City, for example, for Black and brown people is just many times higher than for whites. There's been a lot of discussion about, "Well, do we need to give the vaccines to these folks first?"

There's been no official plan laid out, but we have to first get these vaccines authorized, but Governor Cuomo was actually making a point as well that how you distribute the vaccine could also exacerbate these problems he's pointing out. If you just go through companies like CVS and Walgreens, you could be missing big swaths of the population, maybe the push needs to be made through say Black Churches, for example, those sorts of channels as well to make sure that everybody who really needs this vaccine gets it

Brian: By the way, apparently, a doctor posting on Twitter as famdoc says, "MDs have insufficient real estate. I think we will prioritize the storage of vaccine, even if I have to rearrange my office." So there you go, James in Forest Hills is a skeptic still you're on WNYC. Hi James.

James: Hey, guys. How are you? I just think it's been a little bit irresponsible in terms of the certainty in which some of these numbers have been talked about. These are effectively press releases at this point. I think the weeds is being buried a little bit here, we're talking about a very small sample size. In addition, every one of these articles had an asterisk thing once it's through the full medically peer-review journal, these percentages are subject to change.

When we hear people talking about 90% and 95% that's effectively a press release to take their stock prices higher and we've seen the Pfizer executives get paid. I just want to be a little bit more cautious about how we're talking about that. I'm optimistic and hopeful as anybody we certainly need the vaccine soon, but I'm a little bit concerned about how some of this is being [unintelligible 00:12:12]

Brian: Your phone line is fading in and out, but his point is important. For people who couldn't hear him well these 90%, 94% effectiveness rates are not from peer-reviewed studies. These are from press releases from Pfizer and Moderna and based on small sample sizes of people. Carl, what's your take on that as a science journalist?

Carl: It's certainly true that these are press releases. Press releases reporting on the findings of independent data and safety monitoring boards. To suggest that a press release is a fiction, it might be a little extreme that it's just a goose up stock prices. They're following the protocols that they were agreed upon between these companies and the FDA. They're playing by the rules, they're doing what they agreed to do and they're giving us the results as soon as they're able to.

It's absolutely true that we don't have a lot of information that we still need. For example, if these vaccines continue to prove to be as effective as they seem to be and I will point out Moderna and Pfizer are both giving the same basic range, there's something going on here. Is there's something good going on here, but what does it mean for older people whose immune systems may not respond as strongly to a vaccine? How are they doing in these studies? We don't know yet. How are kids going to respond to this? We don't know yet because they haven't even been tested yet.

There is a lot that we do need to wait to see, but you have to bear in mind that honestly nobody knew if a coronavirus vaccine was going to work at all and everyone was hoping, "Or maybe it'll be 50% effective." If indeed the things follow through as they seem to be that these are 90% or better effective, this is really good news.

Brian: Another listener on the storage track tweets, thanks to climate change. There is a shortage of dry ice. Do you know that to be true?

Carl: I was not aware whether that in itself was true, but if we're depending on Pfizer alone for a lot of vaccines, there's going to be a big demand on dry ice. However, it is worth pointing out that Pfizer and Moderna are not the only players in town. I help run our vaccine tracker and we are keeping track of 54 vaccines that are already in clinical trials right now. I've been able to track down another 87 that are in preclinical stages. This is just the beginning of the story.

Brian: Another question about the rapidity of how this has come to this point from George in Haslett, George you're on WNYC with Carl Zimmer, New York Times science writer. Hi George.

George: Hi, guys great show, thanks. I just wanted to know this RNA, they're all coming out with this RNA now, all the vaccines are going to be on RNA and was it ever tested on animals to any extent? And to what extent does it modify us genetically? Is this a wise thing to start to do to genetically modify the human body and make it mandatory?

Brian: I don't think anybody's making it mandatory, but you did talk about it as a genetic-based vaccine, right? For people who that it might make nervous in the way that George articulates, what does that mean?

Carl: What I'm saying is that there are genetic in this vaccine, the molecule is called RNA. Basically, the RNA gets on your cells, your cells looks at it and says like, "Okay, I'm going to make this viral protein and send it out into the body." What happens at RNA? It's what happens to all our own RNA. It gets shredded. It just gets chopped up into little pieces after the cells are done with it, that's just what happens. There isn't actually a very long half-life as it were for this vaccine, you make a burst of these viral proteins, and then it goes away. You're not being genetically modified, your cells are making proteins in the same way that they would make other proteins, but then that goes away.

It's not like you actually get an extra gene that goes into your own genome. These RNA vaccines have been tested extensively in animals, mice, monkeys, bunch of other animals, they've done challenge experiments where they actually vaccinate monkeys and then expose them to the disease there, but these are not the only kinds of vaccines that are being tested. There are very conventional ones being tested. They just take longer to design and test so there are going to be a whole bunch of different approaches that you'll be seeing going through trials.

Brian: By the way, on the meaningfulness of the studies to this point, Dr. Fauci was on the Today Show this morning, and he said, this news from Moderna that their vaccine trials show 94% effectiveness, "is really quite impressive." Dr. Fauci said-- He said between the Pfizer and Moderna results that this, "is something that foretells an impact on this outbreak" and is a "really strong step forward."

Fauci projected that by the end of December, there will be doses available for people in high risk from the Coronavirus. Who would get it first in these scenarios and would it be state by state? I'm going to lead you next to the weird Cuomo versus Trump back and forth on whether New York would get it like other States, there may be less to this than meets the eye, but is it healthcare workers first necessarily? And then when they say those who are the most vulnerable, does that mean like a 90-year-old with autoimmune issues and diabetes? Or how do they determine that?

Carl: There have been committees that have been meeting to discuss this. Committees of experts from the National Academy of Medicine. The Centers for Disease Control has its own committee of experts who is actually going to come out with recommendations once these things are authorized so we don't know exactly yet what they're going to go for, but it's pretty clear that healthcare workers are going to be top of the list.

There may maybe 20 million of them. they could be just using up the initial supply in December or January and then, but these producers will be cranking out a lot more vaccines after that ramping-up more and more, the hope is to be making maybe a billion a year in each case and then there are other companies are going to be making more. Who would come after healthcare workers? Maybe the elderly who are at such incredibly high risk of death. We mentioned minority communities.

The states may make choices of their own. For example, my colleague Abby Goodnough and Sheila Kaplan in the story that they wrote in the times a couple of days ago, pointed out that the state of Maryland is considering prisoners because prison outbreaks have been horrific because it's just the perfect place for the virus to spread. Maybe prisoners will be getting these vaccines first.

Brian: Can you imagine the politics of that? They're going to give it to criminals before they give it to you in your church? That they're not even allowing you to pray in, you know what I mean? Those kinds of politics will probably break out.

Carl: Well, what we need is good reporting then to make people appreciate the fact that these prisons are becoming slaughterhouses. So many people are dying in prisons, it's horrific.

Brian: Nursing homes and prisons certainly.

Carl: Yes. Nursing homes are definitely going to be high in the list and there CVS and Walgreens, I believe have an agreement with the government to actually be going into some of these nursing homes to deliver the vaccines. It's going to be a huge logistical challenge to reach these vulnerable people. Not just once, but twice, because right now almost all of the vaccines and trials you need two doses separated by three or four weeks. Logistically, you really need a huge amount of preparation.

Brian: When they say seniors, there's a big difference between, let's say a healthy 65-year-old and a 95-year-old who's got a serious heart condition. You know what I mean? When they say seniors are going to be a category, and I keep seeing that. Seniors are going to be a category, there's such a wide range within that, that I wonder if the gradations are going to come more finally.

Carl: Well, we'll have to see because certainly there are these co-morbidities, these risk factors like diabetes and obesity and having had cancer that can really put you at much higher risk. We'll see. Maybe, just being a man puts you at greater risk. I don't know if that means that older men will get it over older women. I will see. I suspect it'll be across the board if you're over 65, get in front of the line.

Brian: Governor Cuomo has put together this consortium of, I think it's five states that are going to independently review any vaccine that gets approved by the federal government because Cuomo is making a show of not trusting the Trump process because Trump may be rushing these out to politicize them. Maybe now that the election is over or once December 8th passes and the electoral votes are actually certified, maybe that's when it becomes moot and not until then, but Cuomo doesn't trust anything that comes on Trump's watch. There's going to be an independent review process. Does that mean that the vaccine is gone to be available later in New York than in other States?

Carl: The details of exactly when they're going to do this review and how they're going to do this review are not clear. There've been reports about them organizing these boards and who's going to be on them. Perhaps, Pfizer or Moderna submits their emergency authorization application to the FDA, and they gave those a hundred thousand pages of documentation to the States at the same time, and then they can go and plow through it themselves. It's just not clear exactly what the timing is. They may just say like, "Okay, this satisfies us and we're okay with it." Unfortunately, the details of that are not clear. If we hadn't had all of this uncertainty about whether the vaccines were being rushed then this might've been a moot point.

Brian: Take a call from Sandra in Morristown, you're on WNYC. Hi, Sandra.

Sandra: Hi, interesting show and lots of good information, but I wonder, is this one and you're done vaccine, or is it more like the flu vaccine, which you have to have every year? Is that known yet?

Carl: It's not known. That's a really key important question. You can't know that from just a few months of trial data yet. Coronaviruses, in general, people when they get them as they're mild colds caused by Coronavirus, and it seems like their antibodies last up to a year and fade out, but other people have looked at another corner virus SARS and found that they've had strong antibody responses for years. We just don't know. It's possible that we could-- Maybe we'll need to get one vaccine now and then maybe in a year just get a booster that someone's going to invent that lasts for a long time. We'll see.

Brian: Would an individual be able to tell if the vaccine worked on them, for example, some of the calls and tweets we're getting obviously as you can imagine along the lines of, "Yes, I'll take it. I'm ready to go. I want to see my grandchildren again," that sort of thing. If we know that a vaccine is X% effective, even 90% effective, does that mean that an individual after a few weeks or whatever after having taken the one dose, the two doses, whatever turns out to be the protocol, can somehow get another test and say, "Oh, good. I'm in the 90% on whom it worked," or, "Oh, I'm in the 10% on whom it doesn't." Would it work like that?

Carl: It's theoretically possible. It may be that there's a certain biochemical signature you develop once you get a really strong immunity to the virus. Scientists are still trying to figure out what that signature would look like. I can't make that promise yet. Will see.

Brian: Here's somebody calling in who says he's one of the folks in the Moderna trial. It's Stan in Jersey city. Hi, Stan. Thanks so much for calling in you're on WNYC.

Stan: Hi, Brian, how are you?

Brian: Okay. What you got?

Stan: Well, I was telling the screener I am participating in the Moderna trial from Rutgers University. I've had the initial vaccine and also the booster, the side effects other than some mild flu symptoms for the first shot and pretty bad flu symptoms after the booster things seem to be going pretty well.

Brian: Good. What is pretty well mean though?

Stan: Well, absolutely know no side effects. Aside from the day after the booster, I haven't felt anything. The thing is that it's a blind trial, so it's a 50/50 chance of getting the booster or the placebo. Since I had severe flu symptoms I assumed that I got the vaccine.

Brian: How severe were your severe flu symptoms?

Stan: Well, I'm saying severe, I guess it's relative. I just had chills, little bit of a fever, body aches similar to the flu.

Brian: Thank you very much. Last word react to that caller, Carl, and then we're at a time.

Carl: The safety profile, we're still waiting for all the details to emerge on that, but chances are that will be the kind of thing that people might expect. Just bear in mind, that's a sign that your immune system is at work. When you feel like that it means your immune system is busy building defenses against the Coronavirus.

Brian: Carl Zimmer is author of Planet 0f Viruses and writes about science for the New York Times. We really appreciate all the info today. Thank you so much.

Carl: Thank you.

Brian: We're going to need this. We're going to need something around here. What we need first is behavior change. I don't know if you've heard some of the local outbreak numbers? Mount Vernon has now issued a stay at home order, which has just taken effect because of surging COVID cases in that town in Westchester. There are other hotspots in Westchester and in the Hudson Valley. That's the latest local news is Westchester, Mount Vernon, and elsewhere.

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